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Rationale: The brain and spinal cord comprise the central nervous system (CNS). The brain is divided into three major regions: the cerebrum (the largest portion; also called the gray mater), the cerebellum, and the brain stem. Each region of the brain carries out specific functions.

2. A young male was involved in a motor-vehicle accident and experienced a closed head injury. He has no memory of the events leading up to the accident, but remembers that he was going to a birthday party. What is the correct term to use when documenting his memory loss?

Rationale: The term amnesia means loss of memory; it is common in patients who have experienced a cerebral concussion. Amnesia of events leading up to an injury is called retrograde amnesia. Anterograde amnesia—also called posttraumatic amnesia—is the inability to remember events that occurred—or will occur—after the injury.

2. A young male was involved in a motor-vehicle accident and experienced a closed head injury. He has no memory of the events leading up to the accident, but remembers that he was going to a birthday party. What is the correct term to use when documenting his memory loss?

Concussion

Rationale: This occurs when the brain is jarred inside the skull.

B. Cerebral contusion

Rationale: This is when tissue is bruised and damaged in a local area. It may result in prolonged confusion.

C. Retrograde amnesia

Rationale: Correct answer

D. Anterograde amnesia

Rationale: This is the loss of memory relating to events that occurred after the injury.

Rationale: Manual stabilization of the patient’s head must be maintained until he or she is fully secured to the long spine board. This includes the application of an extrication collar, straps, and lateral immobilization (head blocks). Pulse, motor, and sensory functions must be checked before and after the immobilization process. Do not assess range of motion in a patient with a possible spinal injury; this involves moving the patient’s neck and may cause further injury.

Rationale: The patient’s snoring sounds indicate an airway problem, which must be corrected or he may die. Manually stabilize his head; carefully move it to a neutral, inline position; and reassess his breathing. Do not rotate or hyperextend the neck of a patient with a possible spinal injury; the results could be disastrous.

Rationale: Although the scalp is highly vascular and tends to bleed heavily when injured, scalp injuries are rarely the sole cause of hypovolemic shock in adults. However, they can contribute to hypovolemia caused by injuries elsewhere in the body. Scalp lacerations, deep or superficial, should prompt you to look for more serious underlying injuries, such as a skull fracture. If the injury involves an avulsion, the avulsed flap of skin should be carefully replaced to its original position, not cut away.

6. A 44-year-old man was struck in the back of the head and was reportedly unconscious for approximately 30 seconds. He complains of a severe headache and “seeing stars,” and states that he regained his memory shortly before your arrival. His presentation is MOST consistent with a/an:

Rationale: A concussion occurs when the brain is jarred around inside the skull. It may result in a brief loss of consciousness and occasionally, amnesia. Seeing stars is a common finding following trauma to the back of the head (occiput), as this region is primarily responsible for vision. A concussion—the least severe of all closed head injuries—typically does not result in physical damage to the brain. Compared to a concussion, a cerebral contusion, subdural hematoma, and intracerebral hemorrhage are usually associated with a more prolonged loss of consciousness.

6. A 44-year-old man was struck in the back of the head and was reportedly unconscious for approximately 30 seconds. He complains of a severe headache and “seeing stars,” and states that he regained his memory shortly before your arrival. His presentation is MOST consistent with a/an:

cerebral contusion.

Rationale: This is when brain tissue is damaged and the patient presents with prolonged confusion and loss of consciousness.

Rationale: Epidural hematomas are caused by injury to an artery—usually the middle meningeal artery—that lies in between the skull and brain. Because arteries bleed faster than veins, patients with an epidural hematoma typically experience an immediate and prolonged loss of consciousness as intracranial pressure increases. Subdural hematomas are the result of injury to a vein; therefore, they tend to bleed slowly and usually cause a progressive decline in level of consciousness. Cerebral concussions and contusions may cause a loss of consciousness, but it is typically brief.

Rationale: Blood or other secretions in the mouth place the airway in immediate jeopardy and must be removed before they are aspirated. At the same time, you must protect the patient’s spine due the mechanism of injury. Therefore, you should manually stabilize the patient’s head, logroll him onto his side (allows drainage of blood from his mouth), and suction his mouth for up to 15 seconds. After ensuring that his airway is clear, assess his breathing and give high-flow oxygen or assist his ventilations. Nasal airways should not be used in patients with severe facial or head trauma.

8. Your patient is a 21-year-old male who has massive face and head trauma after being assaulted. He is lying supine, is semiconscious, and has blood in his mouth. You should:

C. manually stabilize his head, logroll him onto his side, and suction his mouth.

Rationale: Correct answer

D. apply a cervical collar, suction his airway, and begin assisting his ventilations.

Rationale: The cervical collar should be applied but manual stabilization must take place first. There are no indications here that the patient’s rate of respirations are inadequate and require assisted ventilations.

Rationale: Excessive traction on the neck, such as what occurs during hanging-type mechanisms, can cause a distraction injury of the cervical spine. Distraction injuries can cause separation of the vertebrae and stretching or tearing of the spinal cord.

Rationale: In general, you should leave a helmet on if it fits snug and does not allow movement of the head within the helmet, the patient’s airway is patent, no airway problems are anticipated, and the patient is breathing without difficulty. If you can easily remove the face guard (often the case with football helmets) and there are no airway problems, do so but leave the helmet on. If the helmet is loose, the airway is in anyway compromised, or the patient has difficulty breathing or is in cardiac arrest, the helmet must be removed.